title: Application of a microsystem-based project to improve the inpatient care of adults with cystic fibrosis.
abstract: BACKGROUND
  Patients with cystic fibrosis (CF) hospitalized for pulmonary exacerbations complained of delayed and missed treatments. We analyzed the complaints and implemented two microsystem-based quality initiatives to improve care.
  
  
  METHODS
  A prospective, observational study using quantitative and qualitative data collection strategies was conducted. Two interventions were implemented: a CF order set followed 9 months later by a self-administration program.
  
  
  RESULTS
  Thirty-six of 40 patients with CF received initial respiratory therapy within 2 hours of admission compared with 1 of 17 before intervention. Initial antibiotic administration time was reduced from a mean of 18 hours to within 4 hours in the majority of admissions after implementation of quality initiatives. The interventions led to improved medication delivery and increased satisfaction. Hospital length of stay for patients with CF decreased from a mean of 9.5 to 7.8 days.
  
  
  CONCLUSIONS
  Application of a microsystem-based strategy that engaged patients and families as well as caregivers brought about substantial changes in CF care delivery, increased satisfaction among staff and patients, and decreased hospital length of stay.
authors.affiliation: Department of Medicine, The Long Island Jewish Medical Center, New Hyde Park, New York, USA. rocohen@nshs.edu
authors.forename: Rubin I
authors.initials: RI
authors.lastname: Cohen
authors.forename: Fatima
authors.initials: F
authors.lastname: Jaffrey
authors.forename: Magda
authors.initials: M
authors.lastname: Fulman
authors.forename: Pat
authors.initials: P
authors.lastname: Maniscalco
authors.forename: Coleen
authors.initials: C
authors.lastname: Ryan-Frank
authors.forename: Geralyn
authors.initials: G
authors.lastname: LaVecchia
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000628:therapy*; D003695:Delivery of Health Care / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000639:trends; D008297:Male; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D012138:Respiratory Therapy / Q000379:methods* / Q000592:standards